Liberals trying to have it both ways on IVF funding
Children are a blessing. A gift. But not an entitlement. That distinction hasn’t stopped Queen’s Park from turning the gift of life into a gift from the government just in time for Christmas. Deliveries due nine months later.
Under pressure from the fertility lobby (infertile couples and fertility clinics know how to press politicians’ buttons), the provincial Liberals have just announced they will follow through on a pre-election pledge to fund in vitro fertilization. In a time of pinched health care budgets — not enough money for home care, fee cuts for all physicians and Quebec cutting back on its own program — Health Minister Eric Hoskins confirmed this month he’d found an extra $50 million to fund initial IVF treatments for up to 4,000 mothers.
This issue has gestated through three election cycles, with the Liberals perennially zigzagging over zygotes.
They promised to study it in their 2007 platform, then decided against public funding in 2011. Then-health minister Deb Matthews called it an expensive and unpredictable procedure, “an additional cost” to an already overburdened budget that soaks up 42 per cent of government spending. Matthews rejected a 2009 government-commissioned report that claimed costs could be recouped by restricting funding to single-embryo implants — discouraging the risky fertility-boosting techniques that give rise to twins and triplets (and medical complications that burden the system).
With good reason. If there are medical grounds for stopping fertility clinics from implanting multiple embryos, then government should surely ban it or regulate it, not pay out ransom to risk-taking doctors.
Ahead of the 2014 election, however, the Liberals reversed themselves again — with Hoskins leading the charge at the cabinet table. Now, after succeeding Matthews as health minister, he gets to implement the policy he argued for.
His timing couldn’t be worse. While announcing funding for high-priced fertility doctors this month, he is simultaneously curbing fees for primary-care doctors and other medical specialists on the grounds that the cupboard is bare.
Hoskins has become Dr. No for OHIP and Dr. Yes for IVF. It’s a mixed message that reflects muddled thinking at Queen’s Park.
Is infertility a disease that qualifies in vitro as a medically necessary treatment? It’s an emotional debate. Hoskins artfully dodges the question by avoiding the word “medical,” saying only, “Infertility is a serious issue.”
Moreover, Hoskins won’t use OHIP to fund fertility clinics, opting instead to pay them out of a separate health ministry envelope — neatly avoiding the “medical necessity” question for same-sex couples and singles. But it’s a bureaucratic dodge, because it all comes out of one big budget.
Here’s a bigger question: Is there a right to have children? More precisely, is there a right to bear children at public expense?
Hoskins talks about helping Ontarians “grow their families,” and says “the government is supporting family-building.”
Lost in the debate about IVF is the distinction between adoption and conception. If the social goal is to grow families, why should childless couples be offered free IVF, yet have to pay their own way if they choose adoption? Is there an implicit biological imperative that takes precedence?
Underlying the argument for public funding is the premise that cost is an unfair barrier to low-income people (and middle-class couples). At $8,000 to $15,000 for each round of IVF, and with a best-case success rate of barely 33 per cent, additional rounds of treatment can push the bill to tens of thousands of dollars.
Yes, IVF is expensive. But the reality is that child rearing is a costly undertaking. If paying for in vitro is a disincentive to having children, are parents truly prepared for the other bills that await them?
If IVF is such a basic right, why is the government paying for only one round of treatment — and excluding the expensive drug costs that are part of the procedure — knowing full well that most couples will still face prohibitive costs? This isn’t sound public policy, it’s pure politics.
This is the same Liberal government that has delisted eye exams for adults, even though optometrists argue that it could help screen for glaucoma and ensure people have full access to vision services. How can IVF procedures with high failure rates take precedence over cost-effective eye exams for all?
The truth is that IVF funding has its roots in Quebec politics, where there was a collective impulse — the French fact — to boost a flagging fertility rate in 2010. Public funding proved so popular that it went 50 per cent over budget, prompting warnings from the province’s health commissioner that costs had to be reined in.
Rather than learning the lessons of Quebec’s IVF fiasco and rethinking (or re-regulating) the fertility industry in Ontario, the government has taken the path of least resistance — and highest cost. At a time when allocating scarce health care resources is more important than ever, this looks like a decision that was more about political necessity than medical necessity. Martin Regg Cohn’s Ontario politics column appears Tuesday, Thursday and Sunday. mcohn@thestar.ca, Twitter: @reggcohn